Provider Demographics
NPI:1205823184
Name:SIMPSON, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 N COOPER LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4622
Mailing Address - Country:US
Mailing Address - Phone:770-333-1300
Mailing Address - Fax:770-432-8312
Practice Address - Street 1:4480 N COOPER LAKE RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4622
Practice Address - Country:US
Practice Address - Phone:770-333-1300
Practice Address - Fax:770-432-8312
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055647207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA609580122AMedicaid
GA37BBGSTMedicare ID - Type Unspecified
GA609580122AMedicaid